| NPI | 1265746432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WA DE60151102) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60151102) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2018-06-22 |